One in three adults with attention deficit hyperactivity disorder (ADHD) reports severe sensitivity to rejection. This occurs so often that leading professionals came up with a name for it: rejection sensitive dysphoria (RSD). But what is RSD exactly?
Rejection sensitive dysphoria is when an individual frequently perceives criticism or rejection. As a result, they experience extreme emotional pain. And not only emotional pain but also pain so intense they struggle to find any words at all to describe it.
William W. Dodson, MD, explains that “rejection sensitive dysphoria appears to be the one emotional condition found in ADHD.” RSD not only impacts emotions. It can result in years of lost opportunities and negative impacts on mental health. It can also produce relationship struggles with friends and family. Understanding how RSD impacts adults with ADHD can make a big difference in learning how to deal with RSD.
How are Rejection Sensitive Dysphoria and ADHD Related?
There are two main reasons that many professionals think rejection sensitive dysphoria and ADHD are almost always linked.
The Criticism Connection
For adults with ADHD, there are few things more humiliating than making mistakes. Particularly if someone notices. Often, avoiding mistakes very important to the adult with ADHD. But employers or family members may not even notice. Yet, the fear of making them remains. According to Dr. William Dodson, It’s estimated that by the time a kid with ADHD reaches his twelfth birthday, he will have been called out for mistakes 20,000 times more than his “neurotypical” peers. When those with ADHD grow up (especially if undiagnosed), their self-esteem has already become very affected by ADHD.
The ADHD Brain
ADHD is brain-based, which means it’s connected to the nervous system. The nervous system links to emotional responses such as frustrations with work performance. Or, anxiety about asking someone out on a date. So when the body’s emotional core a little “off its axis” so to speak, emotional regulation can be a challenge.
Rejection Sensitive Dysphoria and Fight or Flight
In the face of “danger,” human beings are wired for a fight, flight, or freeze. Our brains evolved to do this to protect from threats. For those experiencing RSD, rejection or perceived criticism can feel like a threat to their emotional wellbeing. This is why RSD can cause either avoidance (flight/freeze) or people-pleasing and emotional reactivity (fight). But, in the case of RSD, the perception of failure or rejection is often higher than the actual likelihood or severity of the threat.
How Does Rejection Sensitive Dysphoria Impact Mental Health?
RSD is commonly misdiagnosed as another disorder, such as social anxiety or depression. This is because RSD looks similar and co-occurs with many other mental health concerns.
Rejection sensitive Dysphoria and Anxiety
50 percent of adults with ADHD have anxiety disorders. And many others have anxiety symptoms. While ADHD and anxiety are linked, anxiety symptoms and RSD can also look similar. But, there are differences. Take a look at these common anxiety symptoms.
- Worries you are unable to control
- Muscle tension
- Easily tired
- Can’t sleep
- Sensitive to light and sound (e.g. “on edge”)
- Can’t concentrate due to worries and racing thoughts
While someone with RSD may experience these same symptoms, one major difference between RSD and anxiety is timing. Someone with a generalized anxiety disorder (GAD) feels anxious often for six months. But when someone with ADHD and RSD feels anxious about rejection, it’s situational.
Another major difference is that while an adult might worry in anticipation of a performance, such as playing guitar in public or pitching a new idea at work, someone with ADHD and RSD could predict rejection in any situation. This belief in future rejection can cause anxiety before the event. And, intense dread, shame, and even depression during and afterward.
Rejection Sensitive Dysphoria and Depression
The word “dysphoria” comes from the Greek language, meaning unease or dissatisfaction. When someone with ADHD and RSD experiences rejection, they can go into a deep sense of despair. They’ll struggle with hopelessness and finding value in themselves. The sense of feeling rejected is hard to shake. Moreover, the despair can turn into a depressive episode. In fact, adults with ADHD are three times more likely to experience depression than those without ADHD.
RSD vs. Depression
Although depression and RSD can show up in similar ways, there are differences. Here are some common depression symptoms. If these symptoms are impacting functioning and occurring daily for at least two weeks, they could mean a major depressive disorder diagnosis.
- Feeling hopeless or sad every day
- Negative self-talk
- Overeating or undereating
- Lack of interest in things that once brought you joy
- Feelings of guilt and worthlessness
- Oversleeping or undersleeping
- Uncontrollable emotions
- Feeling helpless
Depression has staying power, while RSD is more situational despair. For example, when someone feels depressed, they think sad, do sad, and feel sad consistently. RSD is like having major depression for the hours or days after a real or perceived criticism. While RSD can turn into depression, they are separate mental health concerns.
How Rejection Sensitive Dysphoria Could Be Impacting Your Life
RSD and Overachieving
Because ADHD can cause fear of rejection, it is often tied to overachieving behaviors. Why? Well for one thing, when an adult has ADHD, it’s easy to become terrified of letting others down. ADHD can have such negative impacts on self-esteem, the actual achievement is often replaced with reasons why “it was just luck.” Even if many parts of life are going well, many adults with ADHD often feel “like a mess inside.” This can result in people-pleasing or working overtime to complete tasks or meet goals.
How does overachieving impact life with ADHD? It’s easy to get into the mantra, “if I do enough, maybe I’ll be enough.” Once that’s the mindset, taking on lots of new projects may cause the person to feel like everything on the to-do list is a “911”. In the end, this could lead to burnout and life dissatisfaction.
RSD and Avoidance
It’s common for adults with ADHD to avoid non-preferred tasks (completing forms and paperwork, etc.). But, RSD is more about avoiding perceived failure. An ADHDer might find themself engulfed in inattention and struggles with concentration. However, rejection sensitive dysphoria might cause someone with ADHD to avoid any perceived risks. Even if they’ve built a business, kept a job, or received a promotion, they might fear rejection. So, they do not take further action.
Common Ways RSD Impacts Avoidance
Avoidance and Dating
Struggles with RSD can affect common parts of dating. For example, having the confidence to ask someone out in the first place. Then, once a relationship gets rolling, dates (and even texting) can easily trigger perceived feelings of rejection.
Avoidance and Work
Work often requires a level of assertiveness. Setting work boundaries is difficult if you believe you’ll be rejected for speaking your mind. Also, asking for raises or going after promotions can feel impossible if you avoid “making waves” at work.
RSD and Feeling Lost
Have you ever said or felt in private, “I just feel so lost!”? The longer unpursued dreams go…well…unpursued, the harder they seem to achieve. For many, rejection sensitivity has a snowball effect. The reality of their talent and skills may be undeniable. Yet, the fear of rejection holds them back year after year.
Rejection Sensitive Dysphoria and Relationships
RSD and People Pleasing
Fear of failure and judgment may cause adults with ADHD to bend over backward for others. This is because criticism for mistakes outside of their control can build up over time. This can turn into negative self-esteem, as well as feeling like they need to work harder to avoid mistakes. As a result, this leads to poor boundaries between work and life. And, overextending in relationships and with family. While ultimately ADHD is a superpower, no one is superman. So, excessive people-pleasing often leads to resentment and losing track of one’s own life.
RSD and Social Anxiety
Social anxiety and RSD are very similar, yet very different mental health concerns. Social anxiety is about fear of negative evaluation. But, after the individual is social and sees their fears are unrealized, it tends to improve. Adults with ADHD and RSD struggle to shake the feelings of exclusion. They may believe that people don’t want them around. Negative views of self not only cause anxiety but a chronic avoidance of relationships for the fear of being unwanted.
ADHD, Rejection Sensitive Dysphoria, and Emotions
ADHD Can Impact Emotional Regulation
First, ADHD is known to impact the intensity of emotions. Because ADHD is a disorder of attention, it’s easy to become consumed with one emotion. Add feelings of rejection and difficulty with emotional regulation, and that intensity grows even bigger.
Second, adults with ADHD often have trouble rebounding from their emotions. They may identify this as one of the biggest challenges of having adult ADHD. So while others can shake the frustration of traffic when they get to work, an adult with ADHD is still frustrated.
How does this impact RSD? If losing your keys makes you angry with yourself, the anxiety of a job interview and the shame if you do not get that job can be explosive.
Emotional Reactivity and ADHD
Because emotions are difficult to regulate for adults with ADHD, it’s challenging not to act upon those emotions. Or, stop them from intensifying. For example, fear may turn into avoidance. Or, anger might make a small disagreement escalate into a big argument. Intense emotional reactivity or overreactions could lead to relationship issues. Thus, causing increased disconnection and isolation.
What makes RSD worse?
While there is no “cure” for RSD, some things do make it worse.
- Not understanding the ADHD Brain. If you have ADHD, not understanding how your unique mind works can lead to low self-esteem. Adults diagnosed later in life who felt invalidated growing up are even more at risk. Getting validation that your mind works differently than others can be healing.
- A lack of hobbies and creativity. Creativity is a person with ADHD’s life force. The more outlets for emotional energy the better. Without ways to channel that creativity, the easier it becomes
- to feel hopeless.
- A lack of support and connection. We all deserve at least a handful of people who appreciate our unique quirks and gifts. Without genuine connection, rejection or criticism (real or perceived) packs a bigger punch.
The Strengths to Rejection Sensitive Dysphoria
The flip side to rejection sensitivity is empathy. It’s tiring to be hypervigilant to what others are thinking. But, that same energy can make it easier to key into other’s emotions. How might this be helpful? Here are some ways:
- Being flexible at work and learning to “read a room.”
- Being thoughtful and helpful in healthy intimate relationships
- Loving your children and understanding their needs.
While RSD can lead to overachieving, it can also lead to a strong drive to succeed. This is why many adults with ADHD are often entrepreneurs, artists, and professionals. Many with ADHD never feel quite good enough. Yet, there are usually many achievements they can take pride in.
What RSD is NOT
RSD is different from being “too sensitive.” While being a deep-feeling person can be true of anyone, adults with ADHD can go to dark places in their minds and emotions. Also, RSD causes ongoing perceived rejection in many parts of life. Whereas someone who is sensitive would not see situations the same way.
What Helps Rejection Sensitive Dysphoria?
When RSD gets triggered, it can create an emotional tailspin. Becoming consumed by your emotional state might lead to shutting down and even exploding. One of the healthiest things someone can do is to recognize and put a name to how they’re feeling. Emotions come in lots of shapes and sizes. Homing in on the right one is important for emotional regulation. Naming emotions for yourself also means you can name them for others. Thus, improving communication and reducing conflict.
Many adults with ADHD report even knowing a little about RSD is helpful. Understanding how and why you are feeling rejected may increase your ability to rethink situations. Or, manage your emotions and actions.
Shame and self-criticism are infectious. Although RSD can make these emotions gut reactions, self-punishment can deepen the wound. To counteract self-punishment, finding ways to self-validate feelings and practice self-care can reduce stress.
Find your tribe. Connection to people who understand and appreciate you is critical. Dealing with the haters is much easier when you have people in your corner.
Connection to Animals
If you have a pet, awesome. Pets love their masters unconditionally. Spending time with them when feeling rejected isn’t just common sense, it’s science. Connecting with animals increases dopamine in the brain.
Why Haven’t I Heard About RSD and ADHD?
Although RSD is commonly reported in adults with ADHD, it’s hard to quantify. This is because RSD is so situationally triggered it would be hard to add it to diagnostic criteria. Yet, many adults with ADHD feel RSD pretty accurately describes how they feel. If you’re struggling with RSD, know that finding ways to manage feelings of rejection is treatable.
Begin Rejection Sensitive Dysphoria ADHD Treatment in Columbus, OH
You can receive support in dealing with your RSD symptoms from our Columbus, OH-based counseling practice. We have caring therapists who specialize in adult ADHD and understand how RSD is affecting your life. We would love to support you in embracing the strengths of RSD.
To start your counseling journey, follow these simple steps:
- Fill out the contact form to schedule a consultation
- Meet with one of our caring therapists
- Learn to make the most of your RSD symptoms
Other Services Offered At Focused Mind ADHD Counseling
If you’d like more help improving confidence and healing from rejection, an ADHD specialist can help. Our Columbus, OH-based counseling practice can help you manage emotions. Because ADHD impacts people in different ways, Focused Mind ADHD Counseling offers a variety of services in addition to adult ADHD treatment. We also offer counseling for men with ADHD, depression counseling for ADHD, and anxiety treatment for ADHD. Contact us today to schedule an appointment with one of our Columbus therapists.